How Do Patients Respond To Treatment
We looked at patients with chronic Lyme diseasethose who remained ill for six or more months following treatment with antibiotics for Lyme disease . The first thing we did was identify different patients as well, high responders, low responders, or non-responders. Well patients responded positively to a survey question asking if they were well or remained ill. Those who remained ill were asked whether their condition had changed as a result of treatment. Those who said they were unchanged or worse were categorized as non-responders. Patients who said that they were better or worse following treatment, were asked how much better or worse. Those who had improved substantially were deemed high responders.
59% of patients had improved with treatment and 42% were either well or high responders. The focus of our study was on this latter group. You might wonder whether 42% response is considered good compared to other drugs. Heres what the prior head of GlaxoSmithKline said about treatment effectiveness rates of drugs in general .
The vast majority of drugs more than 90 per cent only work in 30 or 50 per cent of the people. Drugs out there on the market work, but they dont work in everybody. Dr. Allen Roses, GlaxoSmithKline
So you can see that a 42% rate of substantial improvement is within the range of most drugs on the market.
What Do I Do If I Find A Tick On My Skin
Dont panic. Use fine-tipped tweezers to grasp the tick as close to the skins surface as possible. Pull up with steady, even pressure. Be careful not to squeeze or twist the tick body. Sometimes parts of the tick remain in the skin. You can leave them alone or carefully remove them the same way you would a splinter. Do not use heat , petroleum jelly, or other methods to try to make the tick back out on its own. These methods are not effective.
Wash the area where the tick was attached thoroughly with soap and water. Keep an eye on the area for a few weeks and note any changes. Call your doctor if you develop a rash around the area where the tick was attached. Be sure to tell your doctor that you were bitten by a tick and when it happened.
What Is Lyme Disease
Lyme disease is an infectious disease caused by the bacteria Borrelia burgdorferi. B. burgdorferi is transmitted to humans by a bite from an infected black-legged or deer tick. The tick becomes infected after feeding on infected deer, birds, or mice.
A tick has to be present on the skin for at least 36 hours to transmit the infection. Many people with Lyme disease have no memory of a tick bite.
Lyme disease was first recognized in the town of Old Lyme, Connecticut, in 1975. Its the most common tickborne illness in Europe and the United States.
People who live or spend time in wooded areas known for transmission of the disease are more likely to get this illness. People with domesticated animals that visit wooded areas also have a higher risk of getting Lyme disease.
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The Treatment Of Early Lyme Disease
Christie Choo-Kang, PharmD, BCPSNephrology and Renal Transplant Clinical SpecialistBoston Medical Center
Eileen Tang, PharmD Candidate 2011College of Pharmacy and Allied Health Professions, St. John’s UniversityNew York, New York
Arun Mattappallil, PharmD Candidate 2011College of Pharmacy and Allied Health Professions, St. John’s UniversityNew York, New York
Lyme disease, also known as Lyme borreliosis, is the most common vector-transmitted illness in the United States.1,2 The disease was first recognized in 1975 in a number of children in Lyme, Connecticut, who were initially diagnosed with juvenile rheumatoid arthritis because of overlapping signs and symptoms.1 In 1982, Willy Burgdorfer, PhD, discovered that a spirochete isolated from Ixodes scapularis, a deer tick, was the same spirochete found in patients with Lyme disease.
Confirmed cases of Lyme disease are defined as erythema migrans greater than 5 cm in diameter or one or more objective late manifestations of Lyme disease with laboratory confirmation in patients with possible exposure to ticks. Healthy People 2010 set a goal of a 44% decrease in the incidence of Lyme disease by 2010. Since 2000, the CDC has contributed more than $3.5 million per year for new research on Lyme disease.2
Legal Mandates To Cover Unproven Treatments
The state of Connecticut, meanwhile, enacted a law on June 18, 2009, “to allow a licensed physician to prescribe, administer or dispense long-term antibiotics for a therapeutic purpose to a patient clinically diagnosed with Lyme disease.” The states of Rhode Island, California, Massachusetts, New Hampshire, Vermont, New York, Maine, and Iowa have similar laws.
Massachusetts and Rhode Island have laws mandating insurance coverage for long-term antibiotic therapy for Lyme disease when deemed medically necessary by a physician. In 1999 Connecticut had passed a similar, though somewhat more restrictive law.
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Symptoms Of Post Treatment Lyme Disease
- Include severe fatigue, musculoskeletal pain, & cognitive problems
- Can significantly impact patients health and quality of life
- Can be debilitating and prolonged
Our research indicates the chronic symptom burden related to PTLD is significant. Although often invisible to others, the negative impact on quality of life and daily functioning is substantial for PTLD sufferers.
The chronic symptom burden related to Lyme disease is considerable, as shown on the left side of the graph above, and statistically significantly greater than the aches and pains of daily living experienced by the control group, on the right.
Why This Is Important
The use and duration of antibiotics for chronic Lyme disease treatment is controversial because there is no biomarker that can determine whether the Lyme bacteria has been eradicated in CLD patients. Patients are often told that either chronic Lyme disease does not exist or that it is incurable. If this were true, we would not expect more well and substantially improved patients to be taking antibiotics. Instead, we might have expected the percentage of people using antibiotics to be roughly the same among the patient subgroups.
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How Can Lyme Disease Be Prevented
Unfortunately, there is currently no vaccine for Lyme disease. But you can avoid Lyme disease by avoiding tick bites, checking for ticks, and removing ticks promptly, before they become lodged in the skin. Some tips:
Avoid tick playgrounds: Ticks like low-level shrubs and grasses, particularly at the edges of wooded areas. If youre hiking, try to stay in the center of the trail and avoid bushwhacking. Walk on cleared paths or pavement through wooded areas and fields when possible.
Dress appropriately: Long pants with legs tucked into socks and closed-toed shoes will help keep ticks away from skin. Light-colored clothing helps make ticks visible.
Insect repellant: Products that contain DEET repel ticks but do not kill them and are not 100 percent effective. Use a brand of insect repellent that is designated as child-safe if your child is 1 year or older. For infants, check with your pediatrician about what brands are safe to use. You can also treat clothing with a product that contains permethrin, which is known to kill ticks on contact.
Shower after outdoor activities are done for the day. It may take four to six hours for ticks to attach firmly to skin. Showering will help remove unattached ticks.
- all parts of the body that bend: behind the knees, between fingers and toes, underarms and groin
- other areas where ticks are commonly found: belly button, in and behind the ears, neck, hairline, and top of the head
- anywhere clothing presses on the skin
Tick Saliva With Healing Powers
Many ticks transfer bacteria or viruses that can lead to serious illnesses. If you get bitten by a tick in Germany, you could contract Lyme disease or Encephalitis. But the small animals can also do good. Oxford researchers have recently found out that a protein from the tick’s saliva can block infections, which makes it a potential cure for a certain type of heart disease.
Ticks – a plague for humans and animals alike
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What Is Post Treatment Lyme Disease
Post Treatment Lyme Disease represents a research subset of patients who remain significantly ill 6 months or more following standard antibiotic therapy for Lyme disease. PTLD is characterized by a constellation of symptoms that includes severe fatigue, musculoskeletal pain, sleep disturbance, depression, and cognitive problems such as difficulty with short-term memory, speed of thinking, or multi-tasking. In the absence of a direct diagnostic biomarker blood test, PTLD has been difficult to define by physicians, and its existence has been controversial. However, our clinical research shows that meticulous patient evaluation when used alongside appropriate diagnostic testing can reliably identify patients with a history of previously treated Lyme disease who display the typical symptom patterns of PTLD.
For Memory Concentration And Focus
Improving memory is a challenge. In Lyme disease, short-term memory problems and word-retrieval problems are common. These often improve substantially with appropriate antibiotic therapy. Over time, most patients regain their cognitive function.
When memory is a problem, consider that this could due to a primary problem with attention or with mood. An individual who can’t focus won’t be able to remember because he/she didn’t “attend” to the item in the first place. This happens to all of us when we hear someone’s name at a party if we don’t focus on the name and perhaps make a mental association to the name to enhance memory storage, we will forget that name within minutes. Patients with depression often experience problems with memory and verbal fluency when the depression is resolved, the memory and verbal fluency typically resolve as well.
- Medications: Attention can be improved with certain medications, such as bupropion , atomoxetine , modafinil , or stimulants . Medications that temporarily slow cognitive decline in Alzheimer’s disease or memantine ) have not been studied in Lyme disease.
- There is some evidence that online brain training programs can enhance concentration or processing speed.
- Neurofeedback may be helpful in improving attention, as well as in improving sleep and reducing pain. This has been studied for migraines, fibromyalgia, and ADHD.
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Treatment For Other Forms Of Lyme Disease
People with other forms of disseminated Lyme disease may require longer courses of antibiotics or intravenous treatment with antibiotics such as ceftriaxone. For more information about treating other forms of Lyme disease, see:
The National Institutes of Health has funded several studies on the treatment of Lyme disease that show most people recover within a few weeks of completing a course of oral antibiotics when treated soon after symptom onset. In a small percentage of cases, symptoms such as fatigue and myalgia can last for more than 6 months. This condition is known as post-treatment Lyme disease syndrome , although it is also sometimes called chronic Lyme disease. For details on research into chronic Lyme disease and long-term treatment trials sponsored by NIH, visit the visit the National Institutes of Health Lyme Disease web siteexternal icon.
What Is The Treatment
Most cases of Lyme disease can be effectively treated with 2 to 4 weeks of antibiotics. Depending on the symptoms and when you were diagnosed, you may require a longer course or repeat treatment with antibiotics.
Some people experience symptoms that continue more than 6 months after treatment. Research continues into the causes of these persistent symptoms and possible treatment methods.
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Promising New Lyme Disease Antibiotic May Spare Microbiome
byMayla Hsu, Ph.D.on October 6, 2021
An exciting new finding by. Dr. Kim Lewis of Northeastern University gives hope that Lyme disease can be potentially treated without harming the microbiome
Why is antibiotic treatment for Lyme disease often problematic? A significant side effect of treating Lyme disease is the disruption of the gut microbiome. Since doxycycline, amoxicillin, and ceftriaxone are broad-spectrum antibiotics, they target not only Borrelia burgdorferi, the bacteria that cause Lyme disease, but also other bacteria. For optimal health, a diverse ecosystem of microorganisms live in and on human beings, contributing to our functioning gastrointestinal, cardiovascular, and immune systems. We now recognize that destruction of this ecosystem with broadly-acting antibiotics can be harmful to patients.
The active component they purified and identified is hygromycin A, which was actually first discovered in 1953 by Eli Lilly Co. Since hygromycin A lacks antimicrobial activity against most other pathogenic bacteria, the company never developed it as a therapeutic. But the Lewis group discovered that it is strongly active in killing spirochetes in vitro . They noted in particular that hygromycin A kills Borrelia and Treponema, which are both human pathogens. These bacteria include the species that cause Lyme disease and syphilis, respectively.
View more Science and Research blogs here.
Can Lyme Disease Be Prevented Or Avoided
The best way to prevent Lyme disease is to avoid being bitten by ticks. When you are outdoors, follow these guidelines:
- Avoid areas that are wooded, brushy, or have tall grass.
- Walk in the center of trails.
- Use an insect repellent with at least 20% DEET. It can be put on clothing or sparingly on the skin. Dont apply it to the face or hands of children.
- Treat clothing, tents, or other gear with repellents containing 0.5% permethrin.
- Wear light-colored clothing. This makes it easier to see and remove ticks from your clothes.
- Wear a long-sleeved shirt and long pants. Tuck your pant legs into your socks or boots for added protection.
After you get home, check everything and everyone for ticks.
- Bathe or shower as soon as you can to wash off any ticks that have not attached to you.
- Check your entire body for ticks. Use a mirror for places you cant see. Check your children and your pets. Common tick locations include the back of the knees, groin area, underarms, ears, scalp, and the back of the neck.
- Check any gear you used, including coats, backpacks, or tents.
Tumble dry clothes or blankets on high heat in the dryer for 10 to 15 minutes. This should kill any ticks. If clothes are dirty, wash them in hot water and dry on high heat for 60 minutes.
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For Depression And Anxiety
Both psychotherapy and pharmacotherapy have proven benefits for improving mood. Psychotherapy has many different types such as supportive, dynamic, cognitive behavioral, dialectical behavior therapy, transference focused psychotherapy each of which offers benefit. Pharmacotherapy also has many different types. For depression the first-line options usually are SSRIs, SNRIs, Tricyclics or other agents with more unique modes of action.
A few noteworthy tips on anti-depressant agents:
- Most anti-depressant agents also help in reducing anxiety. However the opposite isn’t necessarily true. Specific anti-anxiety agents such as clonazepam or diazepam may not necessarily help fight depression.
- Most anti-depressants take three to eight weeks before an effect is seen. Therefore, it is unwise to stop an anti-depressant after only three or four weeks, as staying on it another two to three weeks may lead to a good response.
- Dosage makes a difference. Some anti-depressants work fine at low doses some medications however are effective only at higher doses. Some medications are more effective as the dose is i increased. Other antidepressants may have a therapeutic range one has to achieve at least a certain dosage .
Early Lyme Disease Treatment
ILADS doctors are likely to recommend more aggressive and longer antibiotic treatment for patients. They may, for instance, treat high risk tick bites where the tick came from an endemic area, was attached a long time, and was removed improperly. They may treat a Lyme rash for a longer period of time than the IDSA recommends, to ensure that the disease does not progress. They are unlikely to withhold treatment pending laboratory test results.
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Azlocillin Comes Out On Top
The drug, which is not on the market, was tested in mouse models of Lyme disease at seven-day, 14-day and 21-day intervals and found to eliminate the infection. For the first time, azlocillin was also shown to be effective in killing drug-tolerant forms of B. burgdorferi in lab dishes, indicating that it may work as a therapy for lingering symptoms of Lyme disease.
Pothineni and Rajadas have patented the compound for the treatment of Lyme disease and are working with a company to develop an oral form of the drug. Researchers plan to conduct a clinical trial.
Rajadas is also a professor of bioengineering and therapeutic sciences at the University of California-San Francisco.
Other Stanford co-authors are Hari-Hara S. K. Potula, PhD, senior research scientist postdoctoral scholars Aditya Ambati, PhD, and Venkata Mallajosyula, PhD senior research scientist Mohammed Inayathullah, PhD and intern Mohamed Sohail Ahmed.
A researcher at Loyola College in India also contributed to the work.
The study was funded by the Bay Area Lyme Foundation and Laurel STEM Fund.
- Tracie White
Biorepositories And Research Cohorts
Well-characterized samples are an essential tool to help researchers develop and validate new diagnostic tests and to better understand the complexities of LD. Well-characterized sample sets can benefit medical providers, test developers, and the public at risk for LD . It is critical that sample users understand the criteria used to enroll participants, how samples were collected and stored, and what additional clinical and testing data may be available. Additional benefits can be realized when multiple sample users are using the same well-characterized sample sets. Current sample sets available for researchers include the CDC Lyme Serum Repository , the Lyme Disease Biobank , and samples from the Studies of Lyme Immunology and Clinical Events at Johns Hopkins University School of Medicine. Additionally, some investigators also have their own sample collections with, in some cases, blood samples, skin biopsy specimens and synovial fluid which form the basis for collaborative studies .
Lyme Disease Biobank
Lyme Disease Research Center
Long Island Outdoor Worker Cohort
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